Long-Term Outcomes in Moderate and Severe Aortic Stenosis According to Extent of Cardiac Damage.

Background Cardiac damage (CD) significantly affects the prognosis of patients with aortic stenosis (AS).Objectives The aim of this study was to investigate the impact of CD on long-term survival in patients with moderate and severe AS.Methods In a pooled analysis of 2 single-center registries, patients with moderate or severe AS were included according to the presence of early (stages 0 and 1) or advanced (stages 2-4) CD.Results Among 1,096 patients with AS included between 2009 and 2023, 626 patients (mean age 78.9 ± 8.0 years, 33.1% women) had moderate (n = 343) or severe AS (n = 283). Advanced CD was present in 497 patients (79.4%), and the median follow-up duration was 7.4 years (Q1-Q3: 4.2-10.6 years). There was a gradual increase in the risk for 10-year mortality from moderate to severe AS and from early CD (moderate AS: reference; severe AS: adjusted HR [aHR]: 1.42; 95% CI: 0.75-2.72) to advanced CD (moderate AS: aHR: 1.91; 95% CI: 1.22-2.97; severe AS: aHR: 2.77; 95% CI: 1.73-4.45). At a median 347 days, 344 patients (54.9%) had undergone aortic valve replacement (AVR). In patients with advanced CD, AVR was associated with lower mortality compared with conservative management, irrespective of AS severity (moderate AS: aHR: 0.43; 95% CI: 0.28-0.66; severe AS: aHR: 0.27; 95% CI: 0.18-0.39). In patients with early CD, AVR was associated with lower mortality in patients with severe AS (aHR: 0.29; 95% CI: 0.10-0.86), but not in those with moderate AS (aHR: 0.61; 95% CI: 0.25-1.44).Conclusions Ten-year mortality in patients with moderate and severe AS is importantly determined by CD extent. AVR was associated with lower mortality in patients with moderate AS and advanced CD.